This is the accessible text file for GAO report number GAO-04-892T
entitled 'Internet Pharmacies: Hydrocodone, an Addictive Narcotic Pain
Medication, Is Available Without a Prescription Through the Internet'
which was released on June 17, 2004.
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Testimony:
Before the Permanent Subcommittee on Investigations, Committee on
Governmental Affairs, U.S. Senate:
For Release on Delivery Expected at 9:00 a.m. EDT Thursday, June 17,
2004:
Internet Pharmacies:
Hydrocodone, an Addictive Narcotic Pain Medication, Is Available
Without a Prescription Through the Internet:
Statement of Robert J. Cramer Managing Director, Office of Special
Investigations:
[Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-04-892T]:
Mr. Chairman and Members of the Subcommittee:
I am pleased to be here today to summarize the results of our
investigation of some of the business practices of certain U.S.
Internet pharmacies that sold narcotics without a prescription. Our
testimony is part of a larger body of work GAO has performed that is
the subject of a report and additional testimony we are releasing today
that examines issues surrounding the availability and safety of
prescription drugs sold over the Internet and the business practices of
certain Internet pharmacies.[Footnote 1] We conducted our work from
March 2004 through June 2004 in accordance with quality standards for
investigations as set forth by the President's Council on Integrity and
Efficiency.
At your request, Mr. Chairman, we attempted to obtain information about
the sources of hydrocodone[Footnote 2] that we purchased without a
prescription from eight U.S. online pharmacies. Hydrocodone is an
addictive narcotic pain medication, and illicit use of this drug has
increased significantly in recent years. We contacted one of the
pharmacies that had sold us hydrocodone in an attempt to determine the
relationship between the Internet site and the pharmacy that dispensed
the narcotic and to find out what role a physician may have played in
facilitating our purchase. We also spoke to a physician who actually
prescribed the narcotic for one of our purchases and appears to be
operating an Internet drug business that caters almost exclusively to
individuals purchasing hydrocodone. Although the Internet Web site and
the physician have taken some measures to disguise their operation as a
legitimate enterprise, their business practices suggest otherwise.
We determined the location of the pharmacy that we contacted based on
the return address on the package in which the sample was delivered.
Further, posing as a relative of the customer who had purchased
hydrocodone from this Internet pharmacy, one of our investigators spoke
to the pharmacist who dispensed the drug as well as the prescribing
physician. Subsequently, we conducted surveillance of the office where
the physician processes Internet drug orders.
In summary, we found that (1) one can purchase hydrocodone from certain
Web sites on the Internet without providing a prescription or being
examined by a physician; and (2) the Internet pharmacies from which we
made our purchases of hydrocodone charge significantly higher prices
for the drug than walk-in pharmacies. We concluded that those who
participate in Internet drug operations that operate in this manner
appear to be in the business of knowingly servicing, and profiting
from, individuals who may purchase pain medication for illicit
purposes.
Purchases of Narcotic Pain Medication Without Prescriptions:
We obtained hydrocodone from eight domestic Web sites on which we
placed orders without submitting a prescription or undergoing an
examination by a physician. Six purchases, each from different Web
sites, were dispensed by a single pharmacy located in a Southeastern
state. The two remaining purchases were ordered from two separate Web
sites and were dispensed by separate pharmacies located in states in
the Southeast and Southwest.
We obtained the hydrocodone online by completing questionnaires on
which a GAO staff member (the "customer") claimed that he had pain. In
addition, he claimed that his doctor had prescribed hydrocodone for the
pain, but that he had recently lost his health insurance and could not
return to his doctor for a new prescription. Five Web sites sent the
narcotic after receiving our order and credit card payment information.
We received telephone calls from the three other suppliers before our
order was completed. They asked questions about our purported need for
the hydrocodone and prior use of the drug.
In our attempt to determine the relationship between the Internet site
and the pharmacy that dispensed the narcotic, and to find out what role
a physician may have played in facilitating our purchase, we contacted
one of the pharmacies that had sent us hydrocodone. We also contacted
the physician who "prescribed" a 30-day supply of the narcotic without
seeing or speaking to the customer and without any confirmation from a
physician that the customer had previously been under a doctor's care
or had received a prescription for pain relief.
This specific purchase originated on February 26, 2004, when the
customer, posing as a patient experiencing pain, used a pseudonym to
place an order for hydrocodone. Customers are advised on the site that
they are required to (1) fill out an online questionnaire, (2) receive
a phone call from a medical professional to discuss the customer's
medical condition to determine if he or she is approved for the drug,
and (3) undergo a complete physical examination. If approved, the
medication is billed to the customer's credit card.
Despite the claims on the Web site that customers must satisfy these
requirements, we obtained the hydrocodone without undergoing a physical
examination or producing any tangible evidence showing treatment by a
doctor in the past. Indeed, the customer simply completed the online
questionnaire and spoke by telephone to the physician's representative,
who offered the customer two options for satisfying the physical
examination requirement: (1) for $199, the customer could visit a
physician at one of two clinics in the area where the customer lived;
or (2) for $49, the representative would fax or e-mail paperwork that
the customer could take to his own physician to fill out and return to
the pharmacy's physician. In addition, the representative told the
customer that if he chose and paid for one of these two options with a
credit card during their telephone conversation, the physician would
immediately issue a 30-day prescription so that he could get his
medication right away.
The customer told the representative that he needed to think about both
options. However, the representative reemphasized that if he chose
either the $199 or the $49 option and paid for it immediately, he could
get his 30-day supply of hydrocodone right away. The customer then
chose the $49 option and gave the representative his credit card
information. After the transaction was complete, the representative
reviewed the information that the customer submitted online and said
that he would receive e-mails from her and from the Web site containing
paperwork and information on how to pay for the medication.
The customer then asked if he needed to set up an appointment for a
consultation with the physician, and the representative replied that
she had already completed the consultation. Later that day, the
customer received the paperwork and an e-mail link for a payment site.
He went to the site and used his credit card to pay a total of $190 for
his initial 30-day supply of hydrocodone.
Subsequent Investigation:
Subsequent to receipt of the hydrocodone, a GAO investigator, posing as
a relative of the customer, contacted the pharmacy listed on the return
address of the package in which it was delivered. The pharmacist
confirmed that he had sent the drug and explained that he has a
business relationship with the Web site on which we ordered it, and
with a physician who sent a prescription for it to the pharmacist.
The investigator then telephoned the physician who confirmed that he
prescribed the hydrocodone. The physician claimed that he never writes
prescriptions for new medications for patients and that he always
confirms that the patient has been on the medication in the past. The
investigator asked whether the doctor had actually spoken with his
relative, and the physician responded that one of his associates had in
fact spoken to him. He said that he has a staff of several people who
make such telephone calls to confirm that the customer has been on the
medication in the past. He repeatedly asserted that the staff calls and
speaks with the customer's physician who previously prescribed the
medication. However, he confirmed that the telephone number his staff
had called with respect to our purchase was simply the telephone number
of the customer himself, not that of a physician.
The physician indicated to our investigator that he was handling his
Internet drug business from a clinic he operates. When asked the name
of the clinic, he indicated that it is part of a health care network
and gave a name that does not correspond to the name of any existing
health care network we could find or to any actual medical practice
with which the physician is in fact affiliated. He said to our
investigator, "90 percent of our business is for hydrocodone." He
acknowledged that he currently provides prescriptions for five
different Internet drug sites and disclosed that he previously wrote
prescriptions for two Web sites that have been shut down.
When asked about the possibility of children buying narcotics through
him, the physician claimed that the need for a credit card is the
"safeguard" to prevent that from happening and that "a kid shouldn't
have a credit card." However, he admitted that "parents call [him] all
the time saying that their children have gotten hold of their credit
cards." While he stated that the system can be used by customers to
purchase drugs for illicit purposes, he repeatedly stressed that his
online pharmacy business offers "a service for patients who don't have
insurance, who can't afford to go and see a doctor."
However, this assertion is patently false. To the contrary, the
customer paid a total of $190.00, and an additional $49.00
"consultation" fee, for 60 tablets of hydrocodone that can be purchased
for an average price of about $26.00 at local retail pharmacies at
which we inquired. Thus, we paid nearly ten times the ordinary retail
price of the drug because we did not have a prescription. The Drug
Enforcement Administration provided us with information that the
"street price" or illegal sales price of the hydrocodone we bought
online is about $5 to $6 per pill. Thus, we paid slightly less than the
street price for the drug from this source. The prices we paid for
hydrocodone at the other seven Web sites from which we ordered it were
also significantly higher than the retail price at local pharmacies.
Overall, we paid the eight online pharmacies prices that were 3 to 16
times the price charged for hydrocodone at local pharmacies.
During our visit to the site where the physician purports to operate a
clinic, we saw no evidence of a health clinic. The site is a one-room
storefront set up with several computers and telephones. The only
individuals we saw going to or leaving the storefront appeared to be
employees, and there was no sign on the premises indicating that the
business was health related. When one of the employees was asked what
kind of business is operated at the location, she responded that they
do "computer consultations."
Concluding Observations:
Our investigation revealed that customers can purchase hydrocodone, a
potentially dangerous and addictive controlled substance, from certain
domestic Internet sites that do not require prescriptions. These Web
sites appear to purposely cater to hydrocodone customers who are
willing to pay a substantial markup for the painkillers because they do
not have prescriptions. As a result, these sites appear to be in the
business of profiting from illicit drug use rather than providing a
safe, inexpensive alternative source of drugs for customers.
(601205):
FOOTNOTES
[1] U.S. General Accounting Office, Internet Pharmacies: Some Pose
Safety Risks for Consumers, GAO-04-820 (Washington, D.C.: June 17,
2004); Internet Pharmacies: Some Pose Safety Risks for Consumers and
Are Unreliable in Their Business Practices, GAO-04-888T (Washington,
D.C.: June 17, 2004).
[2] Hydrocodone, a Schedule III controlled substance, is the generic
version of Vicodin.
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